microbial infections through tattoos and piercings
TRANSCRIPT
Dr. Christa De Cuyper
DermatologyAZ Sint-Jan Brugge
Microbial infections throughtattoos and piercings
PIERCING AND TATTOOING: ANCIENT AND MODERN BODY ART
Tattoo: Definition
• The application of colourant(s) on or into the skin
Types
• Temporary tattoo (=superficial):
will disappear in days or weeks
• Permanent tattoo:
- in epiderm and papillary derm will disappear or fade in the next years (=semipermanent)
- dermal deposition will persist (=permanent)
Permanent tattoos
Technique amateurs
Technique professionals
Technique professional
Permanent make-up: technique
• What?– Micropigmentation = tattooing
• How?– disposable oscillating needle
– Pigments and dyes
– + / - local anesthesia
• Risks and complications:
– bleeding
– crusting and swelling
– infection
– allergic reaction
– granuloma
– hypertrophic scar / keloid
– MRI complications
Tattoos and permanent make-up
Infection
–Bacterial
• Common:
–Staph. Aureus
–Group A streptococci
–Pseudomonas spp.
• Exc.
–Tetanos
–Leprosy/syphilis/leishmaniasis
–Tuberculosis / atyp. Mycobacteria
Bacterial infections
ImpetigoImpetigo
UlcerationUlceration
StreptococcusStreptococcus dysgalactiaedysgalactiae
Bacterial infections
• Cutaneous• Impetigo
• Erysipelas / cellulitis
• Ulceration / gangrene
AbscessAbscess formationformation, , methicillinmethicillin--resistantresistant StaphylococcusStaphylococcus
aureusaureus positivepositive. (a) . (a) InitialInitial presentationpresentation, (b) , (b) afterafter abscessabscess surgeysurgey,,
(c) (c) afterafter systemicsystemic antibiosisantibiosis andand negativenegative pressurepressure woundwound therapytherapy
RefRef: Wollina U. Indian Journal of Dermatology 2012; 57(6), 439: Wollina U. Indian Journal of Dermatology 2012; 57(6), 439--4343
Bacterial infections
• Systemic• Sepsis
• Spinal abces
• Endocarditis
• Xanthogranulomatous pyelonephritis (MRSA)
• At risk:• Immunosuppressed patient
• Congenital heart disease
Bacterial infections
Atyp. mycobact. (courtesy ML Pérez-Cotapos)
SporotrichoidSporotrichoid atypicalatypical mycobacteriosismycobacteriosis..
BeforeBefore tripletriple therapytherapy andand at the end of at the end of tripletriple therapytherapy
RefRef: Wollina U. Indian Journal of Dermatology 2012; 57(6), 439: Wollina U. Indian Journal of Dermatology 2012; 57(6), 439--4343
Verrucae planae
Pityriasis versicolor Mollusca contagiosa
•Mycotic
•Viral
•Herpes simplex/ HPV
•Hepatitis B/C/D/G
• HIV
Tattoos and permanent make-up
• Risks and complications:– crusting and swelling
– infection
– allergic reaction
– granuloma– hypertrophic scar / keloid
– MRI complications
�� CourtesyCourtesy Dr. Snauwaert J.Dr. Snauwaert J.
• Risks and complications:– crusting and swelling
– infection
– allergic reaction
– granuloma– hypertrophic scar / keloid
– MRI complications
Tattoos and permanent make-up
�� CourtesyCourtesy Dr. Aberer W.Dr. Aberer W.
Infection
Infections
• Source– Site
– Practitioner
– Host
– Materials: devices
Infections
• Source– Materials: TATTOO INK
Materials
- Carcinogenic aromatic aminesImpurities from the production process
Additives:
- Wetting agents: Glycerine,
Ethyleenglycol
- Preservatives: eg. Witch hazel
- Stabiliser
- Thickeners: Glycerine
- pH-regulators
Solvent
Vehicle: water (H2O)Auxiliary ingredients
Dye
Pigment: eg. Carbon (CI 77266)Colourant
Materials
Granulomatous reactionsIndigoCopper (phthalo-cyanine)CobaltBlue
Phototoxic reactions-Azo dyesCadmium sulfideYellow
Allergic reactions to
mercury,
Phototoxic reactions
Sienna, Brasiline, Carmine
Cochinilla red
Santaline
Azo dyesMercury sulphide (cinnabar)
Cadmium selenide
Red
Allergies for hexavalent
chromium
-Chlorinated copper
(phthalo-cyanine)
Chromium oxide (Casalic green),
Hydrous chromium oxides
(Guignets green)
Chromium sesquioxide (Viridian)
Green
---Ferric oxideFlesh
Rare allergic reactionsManganese oxide--Purple/Lilac
-ManganeseAzo dyes-Violet
---Lead carbonate
Zinc oxide
Titanium dioxide
White
---Ferric oxide, ferric sulphate;
Cadmium sulfide
Brown
-Charcoal, Carbon -Logwood (chrome)Black
-otherOrganicMetalsColours
• Resolution ResAP(2008)1on requirements and criteria for the safety of tattoos and permanent make-up (superseding Resolution ResAP(2003)2 on tattoos and permanent make-up)
• …“Considering that tattoos and PMU may pose a risk to human health due to microbiological contamination and/or the presence of harmful substances in the products used for tattoos and PMU and/or the possibility of being tattooed under questionable hygienic conditions “…
Resolution ResAP(2008)1
• 3.2. …in addition to the requirements set out in paragraph 3.1, tattoo and PMU products must only be used if they comply with all the following requirements
• - they are sterile and supplied in a container which maintains the sterility of the product until application, preferably in a packaging size appropriate for single use. In case multi-use containers are used, their design should ensure that the contents will not be contaminated during the period of use;
Resolution ResAP(2008)1
• - preservatives should only be used to ensure the preservation of the product after
opening and by no means as a correction of
insufficient microbiologic purity in the course of manufacture and of inadequate hygiene
in tattooing and PMU practice; -preservatives should only be used after a
safety assessment and in the lowest
effective concentration.
Resolution ResAP(2008)1
• 3.3. Tattoo and PMU products should contain the following information on the packaging: - the name and address of the manufacturer or the person responsible for placing the product on the market; - the date of minimum durability;1- the conditions of use and warnings; - the batch number or other reference used by the manufacturer for batch identification; - the list of ingredients according to their International Union of Pure and Applied Chemistry (IUPAC) name, CAS number (Chemical Abstract Service of the American Chemical Society) or Colour Index (CI) number; - the guarantee of sterility of the contents.
Microbial status and product labelling of 58 original tattoo inks.
Conclusions :The European Council resolutions regarding
safety of tattoo inks are not effective. Stock bottles of tattoo inkmay contain bacteria pathogenic to humans and environmentalbacteria, and packaging, labelling and preservation of inks are of inadequate quality. Claim of sterility can be erroneous.
RefRef: : HoegsbergHoegsberg et al. JEADV2013, 27, 73et al. JEADV2013, 27, 73--8080
Resolution ResAP(2008)1
• 3.4. Tattooing and the application of PMU –including treatment and maintenance of the
instruments, in particular their sterilisation
and disinfection – must be carried out by the tattooist in conformity with the hygiene
regulations laid down by national public health services.
�� ISBNISBN--PrintPrint: 978: 978--33--642642--0329103291--22
�� ISBNISBN--EbookEbook: 978: 978--33--642642--0329403294--99